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PubMed1983

Reduced lipogenesis in cafeteria-fed rats exhibiting diet-induced thermogenesis.

Fatty-acid synthesis has been measured in vivo with 3H2O in cafeteria-fed rats exhibiting diet-induced thermogenesis. Synthesis was decreased in brown adipose tissue, the liver, white adipose tissue, and the carcass of the cafeteria-fed animals compared to rats fed the normal stock diet. Whole-body synthesis was also decreased in the cafeteria-fed group. Diet-induced thermogenesis, in contrast to cold-induced non-shivering thermogenesis, does not lead to increased fatty-acid synthesis and this is presumably due to the inhibitory effects on lipogenesis of the high dietary fat intake characteristic of cafeteria diets. The results also indicate that the energy cost of body fat deposition in cafeteria-fed rats is lower than in animals fed a low-fat/high-carbohydrate stock diet.

Adipose Tissue↗
PubMed1981

Effects of adenosine 3',5'-cyclic monophosphate on thermoregulation in both rats and rabbits.

The effects of intraventricular administration of dibutyryl adenosine 3',5'-cyclic monophosphate (db cyclic AMP) on the thermoregulatory responses of unanesthetized rats and rabbits to different ambient temperatures (Ta) were assessed. Administration of db cyclic AMP (10-60 mM) produced dose-dependent hypothermia in both rats and rabbits at Ta 2-22 degrees C. The hypothermia in response to db cyclic AMP was due to decreased metabolic heat production and cutaneous vasodilatation. There was no change in respiratory evaporative heat loss. In contrast, in the heat (30-32 degrees C), db cyclic AMP administration produced dose-dependent hyperthermia in these animals. The hyperthermia was due to increased metabolism (due to muscular shivering) and decreased heat losses. The reduction in heat losses was shown by a decrease in both cutaneous circulation and respiratory evaporative heat loss. The data demonstrate that the thermoregulatory responses induced by central administration of db cyclic AMP are Ta-dependent.

Animals↗
PubMed1995

Cardiac output variations in supine resting subjects during head-out cold water immersion.

Five men, aged 31.2 years (SD 2.3), under semi-nude conditions and resting in a dorsal reclining position, were exposed to thermoneutral air for 30 min, followed immediately by a cold water (15 degrees C) immersion for 60 min. Cardiac output was measured using a dual-beam Doppler flow meter. During immersion in cold water, cardiac frequency (fc) showed an initial bradycardia. The lowest values were reached at about 10 min after immersion, 58.3 (SD 2.5) to 48.3 (SD 7.8) beats min-1 (P < 0.05). By the 20th min of exposure, fc had gradually risen to 70.0 beats min-1 (SD 6.6, P < 0.05). This change could be due to the inhibition of the initial vagal reflex by increased catecholamine concentration. Stroke volume (Vs) was significantly increased (P < 0.05) during the whole cold immersion period. Cardiac output, increased from 3.57 (SD 0.50) to 6.26 (SD 1.33) l min-1 (P < 0.05) and its change with time was a function of both Vs and fc. On the other hand, systolic flow acceleration was unchanged during the period of immersion. The changes in the respiratory variables (ventilation, oxygen uptake, carbon dioxide output and respiratory exchange ratio) during immersion showed an initial hyperventilation followed, as immersion proceeded, by a slower metabolic increase due to shivering.

Adult↗
PubMed1995

CD8 T cell activation after intravenous administration of CD3 x CD19 bispecific antibody in patients with non-Hodgkin lymphoma.

A bispecific antibody directed to T and B cells (CD3 x CD19 bsAb) was daily infused intravenously in escalating doses from 10 micrograms up to 5 mg in three patients with chemotherapy-resistant non-Hodgkin lymphoma; in this way we aimed to activate T cells to kill the malignant B cells. Only limited toxicity was observed, consisting of moderate fever preceded by chills or shivers and mild thrombocytopenia. No human anti-(mouse Ig) antibodies were found. Pharmacokinetics showed a t1/2 of 10.5 h with peak levels of 200-300 ng/ml after infusion of 2.5 mg bsAb. bsAb in serum was functionally active in vitro. After bsAb infusion a rise in serum tumour necrosis factor alpha was observed, accompanied by an increase in soluble CD8 and to some extent in soluble interleukin-2 receptor (IL-2R), but not in interferon gamma. IL-4 or soluble CD4. No evidence was found for monocyte activation (no increases in IL-6, IL-8 or IL-1 beta in serum). No gross changes in histology or number of IL-2R+, CD4+ or CD8+ cells were found in the lymph nodes after therapy, but one patient showed activated CD8+ T cells within the tumour nodules. In conclusion, after intravenously administered CD3 x CD19 bsAb only moderate toxicity was found, probably due to CD8+ T cell activation and cytokine release, without CD4+ T cell activation.

Adult↗
PubMed1989

Evaluation of a continuous noninvasive blood pressure monitor in obstetric patients undergoing spinal anesthesia.

A noninvasive blood pressure monitor (Finapres) that continuously displays the arterial waveform using the Penaz methodology has recently been introduced into clinical practice. We compared this device with an automated oscillometric blood pressure monitor (Dinamap 1846SX) in 20 patients during spinal anesthesia for nonemergency cesarean section according to a procedure suggested by the Association for the Advancement of Medical Instrumentation. After administration of the spinal anesthetic, the Finapres monitor produced systolic, mean, and diastolic pressure measurements greater than those of the Dinamap monitor (6.6 +/- 12.5, 3.3 +/- 10.4, and 7.2 +/- 9.8 mm Hg, respectively). In most patients, the Finapres measurements were similar to those determined by the Dinamap; however, in 4 patients, mean systolic differences were greater than 20 mm Hg. These patients did not differ from the others in age, height, weight, or baseline blood pressure, and the pressure values recorded by the Finapres monitor were substantially higher than those measured by auscultation in the labor room. In 30% of the patients, the offset between Dinamap and Finapres blood pressure measurements changed markedly over the course of the surgical procedure. The Finapres monitor occasionally stopped working and had to be restarted. In 1 patient (not included in this analysis), the Dinamap monitor was unable to determine the blood pressure due to patient shivering; this did not appear to interfere with the Finapres. We conclude that the Finapres monitor does not consistently provide blood pressure information equivalent to that of the Dinamap in obstetric patients undergoing spinal anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1975

The regulation of glycerol 3-phosphate oxidase of rate brownadipose tissue mitochondria by long-chain free fatty acids.

Added free fatty acids inhibit oxidation of glycerol 3-phosphate, succinate and NADH in brown-adipose tissue mitochondria from 10-day-old rats. The most pronounced is the inhibitory effect of glycerol 3-phosphate cytochrome c reductase (GP-cyto. c reductase). Contrary to other reductases, GP-cyto. c reductase activity of freshly isolated mitochondria is already inhibited by the fraction of endogenous free fatty acids. Both added and endogenous free fatty acids inhibition of GP-cyto. c reductase is fully reversible by the removal of free fatty acids by bovine serum albumine treatment. The inhibition of GP-cyto. c reductase is of strictly non-competitive type. The most inhibitory are unsaturated long-chain free fatty acids-oleic and linoleic acid. Results are discussed with regards to the regulatory importance of free fatty acids in brown-adiposetissue during intensive non-shivering thermogenesis.

Adipose Tissue, Brown↗
PubMedDate not supplied

Overwhelming postsplenectomy infection with vaccine-type Streptococcus pneumoniae in a 12-year-old girl despite vaccination and antibiotic prophylaxis.

This report describes a 12-year-old girl who developed vaccine-type pneumococcal septicemia (type 4, Danish nomenclature) 2 years after splenectomy for recurrent idiopathic thrombocytopenia despite vaccination with the 23-valent vaccine 4 weeks before surgery and antibiotic prophylaxis with penicillin V. The disease presented as high fever with shivering and vomiting followed by disseminated petechiae and a deteriorated general condition. Initial laboratory studies showed severe sepsis with leucocytopenia and thrombocytopenia, a markedly elevated CRP, and disseminated intravascular coagulation. Despite antibiotic treatment, which was initiated with clindamycin, cefotaxime and trimethoprim/sulfamethoxazole and was switched to cefotaxime and penicillin after the result of the blood culture had been obtained, the patient had to be ventilated, and hemofiltration became necessary because of acute renal insufficiency. Furthermore, she required amputation of all her toes because of severe necrosis. No type-specific pneumococcal antibody titers were detected during and after infection. It remains unclear whether the susceptibility to Streptococcus pneumoniae was due to primary failure of antibody production or a decline in antibody levels after vaccination. Patients and/or their relatives should be informed that neither vaccination nor continuous antibiotic prophylaxis can guarantee full protection against infection with S. pneumoniae in patients after splenectomy.

Bacterial Vaccines↗
PubMed1992

Immobilization of mink (Mustela vison) with medetomidine-ketamine and remobilization with atipamezole.

Four groups of mink were immobilized with medetomidine-HCl (MED) 0.1 mg/kg + ketamine (KET) 5 or 7.5 mg/kg at different ambient temperatures. The induction time, degree of immobilization and analgesia, rectal temperature, heart and respiration rates were recorded at intervals throughout the immobilization period. The animals were then given atipamezole-HCl (ATI) 0.5 mg/kg for reversal at different times after injection of MED/KET and the effects of the antagonist were evaluated. Subcutaneous administration of MED/KET induced complete immobilization in all 20 animals, and the highest dose was considered suitable for major surgery. Prolonged immobilization at low ambient temperatures (-10 to +5 degrees C) caused severe hypothermia in all animals. The mean rectal temperature had dropped to 37.8 degrees C and 32.1 degrees C at 15 and 85 min, respectively, after injection of MED/KET, significantly lower than the corresponding values for animals immobilized at room temperature. Intramuscular administration of ATI 20 or 40 min after injection of MED/KET rapidly remobilized the animals without apparent side-effects. Administration of ATI to animals recovering spontaneously 90 min after injection of MED/KET induced thermogenesis (shivering) in animals immobilized at a low ambient temperature, while no such effect was seen in animals immobilized at room temperature. One hour after injection of ATI, the rectal temperatures of all treated animals had returned to normal and there were no signs of abnormal behaviour.

Adrenergic alpha-Agonists↗
PubMed1989

Rates of energy substrates utilization during human cold exposure.

Although it is well established in animals that acute cold exposure markedly increases the oxidation of energy substrates, the absolute quality and quantity of substrate oxidation is poorly understood in humans. This study compared the rates of substrate utilization in seven healthy young men exposed to both the warm (control exposure at 29 degrees C; semi-nude, 14 h fasted) and to the cold for 2 h (10 degrees C, 1 m.s-1 wind velocity). Substrate utilization was calculated using indirect calorimetry and the nonprotein respiratory exchange ratio, which was derived from the urinary urea nitrogen output. Cold exposure induced a 3.1 +/- 0.2 degrees C drop in mean body temperature and a body heat debt of 825.9 +/- 63.3 kJ (p less than 0.01). These parameters remained essentially unchanged in the warm. Cold exposure elevated the 2 h energy expenditure 2.46-fold in comparison to the warm (p less than 0.01). This cold-induced thermogenesis was accompanied by increases of 588% in carbohydrate oxidation (p less than 0.01) and 63% in fat oxidation (p less than 0.05), whereas protein oxidation remained unchanged. Although the greatest proportion of the energy expenditure in the warm was derived from lipid (59%), carbohydrate oxidation represented the major fuel for thermogenesis in the cold, since it accounted for 51% of the corresponding total energy expenditure. The results demonstrate that cold exposure causes a much greater increase in the utilization of carbohydrate than lipid. It is suggested that these substrates are directly utilized for thermogenesis in the shivering skeletal muscles.

Adult↗
PubMed1991

Acute suppurative renal inflammation.

Diagnostic and therapeutic aspects of acute suppurative renal inflammation are discussed in connection with 374 cases. Despite negative X-ray and laboratory findings, patients were submitted to operative exploration and 27% of them revealed subcapsular abscesses. Anamnestic facts (fever, shiver, etc.) and closely observed progression in the patient's morbid condition are factors to indicate surgery. Better results from the second part of the observation period (1981-1989) are due partly to better timing of the surgical intervention, partly to modern, highly effective chemotherapy. The mortality rate of acute suppurative renal inflammation dropped from 11 to 3.5%.

Acute Disease↗
PubMed1999

A new scoring system for the clinical diagnosis of catheter-related infections.

It is difficult to make the clinical diagnosis of catheter-related infections using the available and established definitions of the HICPAC (Hospital Infection Control Practices Advisory Committee) of the CDC (Centers for Disease Control, definitions of nosocomial infections). The scoring system shown here is a modification of these definitions and has enabled the causal relationship between the catheter and clinical episodes of systemic infections to be quantitatively graded. The scoring system included the following criteria: height and rate of rise of body temperature, attendant shivering, identification of pathogens in blood and/or catheter tip cultures, improvement in the clinical course after catheter removal, signs of catheter exit site inflammation and results of diagnostic tests for other possible sources of infection. These criteria were graded using points and weighted according to their specificity. The comparative evaluation of 65 episodes of systemic infections using the scoring system and the diagnostic criteria of HICPAC showed agreement in 85%. No case was graded "false-negative." In nine of ten false-positive cases additional findings supported the presence of a catheter-associated infection. This scoring system appears, therefore, to be more sensitive than existing diagnostic criteria, without loss of specificity.

Catheterization, Central Venous↗
PubMed1987

Alteration of the alpha-tocopherol content in the brain and peripheral nervous tissue of dysmyelinating mutants.

In the brain of quaking and shiverer mutants, vitamin E content was normal when related to both wet weight and dry weight. When related to lipid extract, phosphorus, and polyunsaturated fatty acids, vitamin E was slightly increased only in the quaking mutant. In the sciatic nerve from trembler mutants, vitamin E was 134% of control values in the dry material, but normal in relation to wet weight. It was 260% in the lipid extract and 716% based on phosphorus. In relation to total fatty acids, there was a threefold increase in trembler mutants. Interestingly, it was increased approximately three times when related to 18:2 n-6, 20:4 n-6, and 20:5 n-3, and seven times when related to 22:6 n-3. The fact that the amount of vitamin E in fresh weight was normal, suggests that vitamin E plays a role in some nonmembrane material, such as the extracellular matrix or the basal lamina.

Animals↗
PubMedDate not supplied

Efficacy of amphotericin B in multi-drug resistant kala-azar in children in first decade of life.

Fifty children in the first decade of life, and suffering from multiple drug resistant kala-azar, confirmed by demonstration of amastigotes in aspirates of bone marrow or spleen were treated with amphotericin B in gradually increasing dosage to a total dose of 20 mg/kg. All patients had classical features of severe kala-azar, and had taken more than one course of antimony and pentamidine, and three patients had taken one additional course of ketoconazole besides many courses of antimony and pentamidine. The clinical response started just after first infusion in 8 patients, and the patients became afebrile. By 5th infusion, all looked better and 18 patients became afebrile. By 15th infusion all patients were afebrile and cheerful. Their spleens became smaller and body weights and total white cell counts increased. Forty eight patients had parasitological cure at the end of treatment, and only 2 patients required an additional 5 infusions for parasitological cure. All patients were ultimately cured. No one relapsed within six months of follow up. All patients had shivering, rigor and rise of temperature on the day of infusion, which could be minimized with prior administration of low dose of hydrocortisone, but could not be eliminated. Eighteen patients had loose motions during treatment, while 14 patients had decrease in appetite which improved quickly when the treatment was over. Fourteen patients had transient rise of blood urea, in six patients serum creatinine also increased and 16 patients had a minor fall in serum potassium.(ABSTRACT TRUNCATED AT 250 WORDS)

Amphotericin B↗
PubMed2004

Brown adipose tissue: evaluation with 201Tl and 99mTc-sestamibi dual-tracer SPECT.

Brown adipose tissue is one kind of adipose tissue and regulates body temperature and balance of energy via non-shivering thermogenesis. The authors present a case that strongly suggested the presence of activated brown adipose tissue in the neck, shoulders and axillary space by increased 18F-FDG uptake. 99mTc-sestamibi and 201Tl dual-tracer SPECT study showed increased 99mTc-sestamibi uptake and non-increased 201Tl uptake in the corresponding 18F-FDG uptake sites. Brown adipose tissue has dense mitochondria in the cells, which play an important role in thermogenesis. 99mTc-sestamibi uptake and retention depend on the mitochondrial activity but 201Tl uptake does not. Therefore, the activity of mitochondria in activated brown adipose tissue may explain the discrepant uptake between 99mTc-sestamibi and 201Tl.

Adipose Tissue, Brown↗
PubMed1978

Asymptomatic diaphragmatic defect--a post-operative problem.

A three-hour operation on the maxilla of a woman with an unrecognized large left diaphragmatic defect using narcotic-supplemented nitrous oxide anaesthesia resulted in near-complete compression of her left lung. The condition remained asymptomatic until post-operative shivering increased the patient's metabolic requirements, leading to signs of air hunger. Aspiration of large amounts of gas from the stomach promptly relieved all symptoms in spite of significant residual X-ray findings. It is important to keep in mind that the early post-operative period is usually one of intense metabolic activity rather than of rest. Patients who are unlikely to cope with such demand should be identified pre-operatively and supported prophylactically by ventilatory assistance, ample supply of metabolic substrates and judicious sedation.

Anesthesia, General↗
PubMed1981

Studies in fentanyl-supplemented anaesthesia: awareness and effect of naloxone on early post-operative recovery.

Ninety-nine unselected patients were given a standardized general anaesthetic with fentanyl 1.5 microgram . kg-1 every 30 minutes and were randomly divided into three equal groups; Group I patients received naloxone 0.1 mg. Group II naloxone 0.2 mg and Group III naloxone 0.4 mg intravenously at the end of the operation and after the reversal of neuromuscular blockade. After naloxone the level of consciousness lightened and the response to stimulus increased: the changes were significant in all three groups and the actual changes were significantly greater in Groups II and III compared with Group I. In the Recovery Room there was no significant difference among the Groups for shivering, nausea, vomiting or pain. The incidence of operative awareness was one per cent and that of dreaming eight per cent and this was unrelated to naloxone dosage. Patient acceptance was high, seven patients not wanting this type of anaesthesia again due to (a) light premedication (inherent in the study design), two patients; (b) nausea and vomiting, four patients; and (c) slow awakening, one patient.

Anesthesia↗
PubMed1990

Antagonism of benzodiazepine-fentanyl anaesthesia with flumazenil.

The specific benzodiazepine antagonist flumazenil (Ro 15-1788) (Ro) was given in a double-blind study to 40 adult orthopaedic patients in order to determine if it shortens the immediate recovery time after benzodiazepine-fentanyl anaesthesia. On the evening before operation the patients were premedicated orally with 1-2 mg of flunitrazepam and 30 min before the induction of anaesthesia with 7.5 mg midazolam. Induction of anaesthesia was carried out with flunitrazepam 0.03-0.04 mg.kg-1 and fentanyl 0.1 mg IV. Anaesthesia was maintained with fentanyl (5.9 microgram.kg-1.h-1) and nitrous oxide. After the reversal of muscle relaxation, 20 patients received a placebo and 20 patients Ro, as boluses up to 10 ml, until the effect of awakening was noticed. The dose of Ro (0.1 mg.ml-1) required was 6.8 +/- 2.9 micrograms.kg-1 and that of placebo 10 +/- 0 ml. Patients given Ro woke up faster than patients given placebo. Ro patients were more alert than patients given placebo until 120 min after the injection or the test drug. After this patients in both groups behaved similarly. Eight patients given Ro and one given placebo showed some mild adverse reaction for 5-60 min after the administration of Ro or placebo (e.g., nausea, shivering). This study indicates that flumazenil speeds up awakening after benzodiazepine-fentanyl anaesthesia.

Adult↗
PubMed1992

MAO inhibitors and coronary artery surgery: a patient death.

The mechanisms of action of monoamine oxidase inhibitors (MAOIs) suggest that patients taking them may respond with hyper- or hypotension when undergoing coronary artery surgery. We describe a case where MAOIs were present and fentanyl and midazolam were the anaesthetic agents used. The anaesthesia and surgery were performed without incident. Postoperative ICU care was complicated by hypertension, hyperthermia, and severe shivering followed by hypotension resistant to therapy and finally death. Diagnoses of pulmonary embolism and sepsis were unproven and may have played a role. The MAOIs may also have played a role. Reactions in patients while taking both meperidine and MAOIs are unusual and animals react differently from humans to a combination of MAOIs and narcotics. There are only five reported cases where fentanyl was given to patients on MAOIs. We conclude that, until there is more information, MAOIs should be discontinued, if possible, before surgery in which catecholamines may be needed.

Acidosis↗